Parasit. Hung. 2. 55-70.1969
Effect of Giardiasis upon Vitamin A Metabolism
Dr. Magda E M B E R — László
MINDSZENTY
Institute for Public Health and Epidemiology, Szeged
Almost w i t h o u t e x c e p t i o n , p u b l i c a t i o n s d e a l i n g w i t h n u t r i t i o n a l d i s o r d e r s make t h e p o i n t t h a t s t a t i s t i c a l data a r e based on severe cases o f a v i t a m i n o s i s . A c c o r d i n g t o s p e c i a l i s t s o f FAO and WHO, a t r u e p i c t u r e cannot be o b t a i n e d f r o m these d a t a , be cause they t a k e no account o f . t h e l e s s severe forms o f v i t a m i n d e f i c i e n c y , o f w h i c h a d i a g n o s i s can be e s t a b l i s h e d o n l y by b i o c h e m i c a l methods. I n t h e WHO C h r o n i c l e (1965) t h e r e i s a r e p o r t on t h e g e o g r a p h i c a l i n c i d e n c e o f v i t a m i n d e f i c i e n c i e s ( 3 2 ) . On t h e map o f t h i s r e p o r t i t would seem t h a t a v i t a m i n o s i s does n o t e x i s t i n Hungary. A t best t h i s i s t r u e o n l y f o r p r i m a r y a v i t a minosis. I n most cases v i t a m i n A d e f i c i e n c y i s ( l 6 ) , t h e r e s u l t o f a d i e t poor i n v i t a m i n s and p r o t e i n s and i s c a l l e d p r i m a r y v i t a m i n A d e f i c i e n c y . V i t a m i n A d e f i c i e n c y can a l s o occur i n secondary f o r m f o r even i f t h e v i t a m i n source i s adequate c e r t a i n i n d i v i d u a l s develop h y p o v i t a m i n o s i s as a r e s u l t o f i n f e c t i o n , fever or other disease. I n these cases t h e h y p o v i t a m i n o s i s i s mostly subclinical. The
present i n v e s t i g a t i o n
deals
w i t h secondary v i t a m i n A d e f i
c i e n c y caused by g i a r d i a s i s .
* Paper p r e s e n t e d a t t h e V l l t h I n t e r n a t i o n a l N u t r i t i o n , Hamburg, August 3-10 1966.
Congress o f
Only a f e w f a c t s a b o u t t h e i m p o r t a n c e o f G l a r d i a l a m b l i a
(Lamb
l i a i n t e s t i n a l i s ) a r e summarized h e r e . C l i n i c a l symptoms o f t h e d i s e a s e i n Hungary were a d e q u a t e l y d e s c r i b e d a s e a r l y
as 1937
( 3 0 ) , when m a l a b s o r p t i o n a n d a n o r e x i a were emphasized. C l i n i c a l o b s e r v a t i o n s s u g g e s t t h a t t h e average d u r a t i o n i s from 2 t o 3 years (12). fective
absorption
o f the i n f e c t i o n
KATSAMPES e t a l . ( 8 ) o b s e r v e d a de
of vitamin A
i n children
infected
w i t h G.
lamblia;
X-ray e x a m i n a t i o n s (19)»electronmicroscopic and b i o p s y
studies
(29, 33), carried out i n various
states.of
giardiasis,
consistently
adhering
t o t h e small
intestine
clinico-pathological
prove causes
that
this
protozoon
malabsorption, w i t h a
r e s u l t a n t decrease i n t h e l e v e l s o f v i t a m i n s A and D and sub sequent
retardation
o f g r o w t h . A c c o r d i n g t o MAXARA (12) t h e i n
c i d e n c e o f g i a r d i a s i s i n c h i l d h o o d i s 5 t o 20 p e r cent;however, he
s t r e s s e s t h a t t h i s l e v e l c a n be as h i g h a s 50 t o 80 p e r c e n t
i n c h i l d r e n l i v i n g i n communities, a t t h a t age when t h e v i t a m i n
and i n f e c t i o n o c c u r s m o s t l y
storage
i s a t i t s lowest
q u i r e m e n t i s h i g h e s t . A c c o r d i n g t o MOORE ( 1 5 ) f o r m a t i o n on how much v i t a m i n thogenicity
o f G. l a m b l i a
tamin A malabsorption, ing,
status
A a c h i l d can s t o r e .
I f t h e pa
e a r l i e r r e s u l t s ( 4 , 5) are n o t s u r p r i s of infected
c o u l d be o b s e r v e d i n
the
vitamin
had
been l i v i n g i n s t a t e homes f o r many y e a r s
f e d on t h e same d i e t .
and u n i n f e c t e d
c h i l d r e n who
an-d who h a d been
The a u t h o r s gave e v i d e n c e t h a t t h i s d i f
f e r e n c e was due t o G. l a m b l i a
infestation.
With the present i n v e s t i g a t i o n whether v i t a m i n A d e f i c i e n c y and
re
i s c o n s i d e r e d a p o s s i b l e cause o f v i
namely t h a t a s i g n i f i c a n t d i f f e r e n c e A
and
there i s l i t t l e i n
the authors
wished t o e s t a b l i s h
o c c u r s i n „healthy c y s t
carriers"
w h e t h e r i t i s a secondary r e s u l t o f g i a r d i a s i s .
Materials
a n d Methods
The
e x i s t e n c e o f g i a r d i a s i s i n two s t a t e homes - one i n Szeged
and
one i n Szegvár
( S o u t h e r n Hungary) - was d e t e r m i n e d by t h e
d i r e c t smear t e c h n i q u e ,
using iodine
stain;
a t t h e same
time
the v i t a m i n A status
and
t h e v a l u e o f serum c a r o t e n e were de
t e r m i n e d f r o m venous f a s t i n g b l o o d . A l l measurements were a t t h e same r e l a t i v e t i m e on t h e days b e f o r e
t i o n o f t r e a t m e n t s and d i e t a r y s u p p l e m e n t a t i o n s . of the vitamin 17).
was
carried
The b e t a - c a r o t e n e state
Determination
Out "by t h e TEA-colour r e a c t i o n ( 5 ,
c o n t e n t o f c a r r o t s used f o r s u p p l e m e n t a
t i o n o f d i e t was d e t e r m i n e d c i a n s o f these
by KRAMER'S method ( 9 ) .
homes
had
not
observed
The p h y s i
any
symptoms i n t h e c h i l d r e n , h e n c e they had n o t c o n s i d e r e d sibility
o f g i a r d i a s i s b e f o r e our i n v e s t i g a t i o n s .
f e c t e d c h i l d r e n as c o m p a r a t i v e we t r i e d , i n d i f f e r e n t ways, of the infected
taken
and a f t e r comple
controls,
living
to influence
clinical t h e pos
Taking
unin
i n s t a t e homes
the v i t a m i n A
status
children:
a. / w i t h v i t a m i n A b. / w i t h raw c a r r o t
administration, administration,
c. / w i t h a d m i n i s t r a t i o n d. / w i t h t h e c o m b i n a t i o n
o f a n t i p a r a s i t i c d r u g s , and o f d r u g and v i t a m i n
I n a d d i t i o n , we had t h e o p p o r t u n i t y
to carry
f o r 6 weeks on 10 i n f e c t e d c h i l d r e n ,
administration. out i n v e s t i g a t i o n s
as a g a i n s t f o u r , who were
used as c o n t r o l s , a n d a g a i n on 10 i n f e c t e d s u b j e c t s f o r 3 y e a r s . The main purpose o f o u r o b s e r v a t i o n s
was
to establish a rela
tionship
and
reinfestation
between
vitamin A
status
after
treatments.
Results a./ Ten i n f e c t e d c h i l d r e n r e c e i v e r on two c o n s e c u t i v e days w i t h o u t f o u r t h day
of
l e v e l was s t i l l
experiment
150,000 I . U . v i t a m i n A* d a i l y
therapy
following
(E i g . treatment
1).
On t h e
the vitamin A
h i g h i n comparison w i t h t h a t o f t h e c o n t r o l b u t
l a t e r had f a l l e n a g a i n t o t h e s t a r t i n g l e v e l . I n agreement
with
* Egyesült Gyógyszer- és Tápszergyár ( B u d a p e s t ) , 50,000 I.IT. axerophth. per capsules.
500 SVA IU/400ml 400-
<<
300
11 il
200
SS
r -
«O
m
1 2 3 k 5 6 7 8 9 10 N .
4
2 3
1 2 3 4 5 6 7 8 9 « H M
5
o
3
6.7 fi 3 1011 T Days-Napok
CZI
I n f e c t e d C h i l d r e n - Fertőzött gyermekek
€3
U n i n f e c t e d C h i l d r e n - Nem fertőzött gyermekek
ESS
U n i n f e c t e d A d u l t s - Nem fertőzött felnőttek
Fig.
l - l .
ábra
E f f e c t o f O r a l A d m i n i s t r a t i o n o f V i t a m i n A upon t h e V i t a m i n A S t a t u s o f C h i l d r e n . The serum v i t a m i n A (SVA) c o n c e n t r a t i o n i s h i g h e r i n i n f e c t e d c h i l d r e n t h a n i n h e a l t h y c h i l d r e n on t h e day f o l l o w i n g a d m i n i s t r a t i o n ( a b s o r p t i o n time i s d e f i c i e n t ) . After a f u r t h e r 2 days t h e SVA o f i n f e c t e d c h i l d r e n f a l l s t o i t s f o r mer l e v e l . Per os a d a g o l t A v i t a m i n hatása az SVA-ra. Az adagolást követő napon a fertőzöttek SVA s z i n t j e magasabb,mint az azonosan suppJementált egészséges egyéneké. (Az a b s o r p t i o kóros.) Két u j a b b nap elteltével a cystahordozók SVA-ja a kiindulási értékre esett vissza.
t h e r e s u l t s o f KATSAMPES•s e t a l . (8) v i t a m i n A t e s t s , we f o u n d that
absorption
e f f i c i e n c y was i m p a i r e d
w i t h G.L. However w i t h a h e a l t h y m i n o s i s was n o t
i n patients
c o n t r o l c h i l d , whose
due t o g i a r d i a s i s , t h e v i t a m i n
normal a f t e r supplementation. does n o t b r i n g a b o u t
Thus,
improvement
s p r i n g months
could o b t a i n only group o f ten food,
carrots
infected
o f the
vitamin A
children
as a n a t u r a l
living
i n the
vitamin A
IU/100 m l ) ;
status
152,0
o f carotene.
A
besides t h e i r d a i l y carrots
(median:
over
f r o m 4-2,8 IU/lOO m l t o 51,0
on t h e o t h e r hand t h e r e was a s i g n i f i c a n t i n c r e a s e
g/lOO m l ) ;
( m e d i a n : ' f r o m 63,0
/ig/lOO m l t o
indicating that giardiasis disturbs
t h e con
o f b e t a - c a r o t e n e t o v i t a m i n A.
c. / Of 29 i n f e c t e d c h i l d r e n 21 were t r e a t e d w i t h a t a b r i n e imidazole derivatives. was
a
t h i s caused no s i g n i f i c a n t change
i n t h e l e v e l o f serum c a r o t e n e version
status, (16).
i n s t a t e homes
source
p a t i e n t s was g i v e n ,
However,
remained
s u p p l e m e n t a t i o n by i x s e l f
6 mg o f b e t a - c a r o t e n e i n t h e f o r m o f g r a t e d
a f o u r day p e r i o d .
hypovita
level
f i n d i n g c h a r a c t e r i s t i c o f secondary h y p o v i t a m i n o s i s b. / I n t h e e a r l y
infected
Recovery
from
the parasitic
checked by r e p e a t e d e x a m i n a t i o n s o f t h e
8 with
infection
s t o o l s . W i t h o u t any
d i e t a r y change s u c c e s s f u l t r e a t m e n t w i t h b o t h drugs r e s u l t e d i n a
s i g n i f i c a n t increase
52,5
i n the vitamin A
IU/100 ml t o 90,0 IU/lOO m l )
i n w h i c h t r e a t m e n t was n o t mained unchanged. of
serum
(P i g . who
carotene
(P i g .
(median: I n four
fell
i n r e l a t i o n t o the r i s e
t h e same t h e r a p y
caused by t h e change ments ( 1 4 ) .
as i n f e c t e d
seek t o d e t e r m i n e w h e t h e r i n the
ratio
o f the
GUGGENHEIM (15) r e p o r t e d
prolonged treatment w i t h atabrine,
level
i n vitamin A
3 ) . D o t t e d l i n e s i n t h e ' f i g u r e r e f e r t o the
received
from cases
e f f e c t i v e , the v i t a m i n A s t a t u s r e
As a r e s u l t o f s u c c e s s f u l t h e r a p y , t h e
investigations w i l l
tic
status 2).
volunteer
subjects.
Future
the r e s u l t s a r e
active-inactive pig
t h a t when r a t s were g i v e n
an a n t i - m a l a r i a l d r u g , hepa
s t o r a g e o f v i t a m i n A was a d v e r s e l y
affected.
d. / Ten c h i l d r e n r e c e i v e d a combined c u r e , n a m e l y , a f t e r
treat-
SVA Vt¥X)ml
A B C D E F G H
I
Î K L M N 0 P R 5 T T I / V X 7 Z
@ No c y s t s p r e s e n t i n s t o o l - Cysták a székletben n i n c s e n e k VWk
C y s t s p r e s e n t i n s t o o l - Cysták a székletben
Pig.
2 - 2 . ábra
Changes i n Y i t a m i n A S t a t u s C h i l d r e n Cured by A n t i p a r a s i t i c D r u g s ( a t a b r i n e o r i m i d a z o l e d e r i v a t i v e s ) . A-Z r e p r e s e n t successfully treated patients, a-d p a t i e n t s s t i l l c a r r y i n g c y s t s . Az SVA változása gyógykezelés ( a t e b r i n , i l l . i m i d a z o l származék) hatására. A-Z jelölteknél nem l e h e t e t t cystát k i m u t a t n i a kezelés után,mig a-d kezeiteknél a cystahordozás még f e n n m a r a d t .
SC BgttÛrri
S\A IMOOml
— Daus-Napok I , 1 , 1 , 1 , I , î , I , * , ^ PrePostPrePosttherapy
• ÙC
- I n f e c t e d . C h i l d r e n - Fertőzött gyermekek -Ù, H e a l t h y P a t i e n t - Egészséges egyén
Pig. 3 - 3 .
ábra
I n v e r s e Changes i n t h e L e v e l s o f Serum Carotene (SC) and o f V i t a m i n Á (SVA) i n C h i l d r e n a f t e r E f f e c t i v e T r e a t m e n t w i t h A t a b r i n e . T h e b r o k e n l i n e r e p r e s e n t s a human v o l u n t e e r t r e a t e d w i t h a t a b r i n e whose SVA d i d n o t a l t e r . His diet contained n e i t h e r v i t a m i n A nor carotene during treatment. Az SC és az SVA ellentétes változása eredményes a t e b r i n k u r a hatására. A k u r a nem befolyásolta az SVA értéket önként j e l e n t k e z e t t egészséges egyénnél, a k i n e k étrendje a k u r a a l a t t nem t a r t a l m a z o t t sem A v i t a m i n t , sem k a r o t i n t .
ment w i t h a t a b r i n e on the s i x t h ment they that
were
given' daily
the i n c r e a s e
IU/100 ml t o 93,0 c h i l d r e n who
were
recovery
from
sorption
time.
i n their
seventh day
o f the e x p e r i
150,000 IU v i t a m i n A. vitamin A
IU/100 ml) treated
and
was
similar
to
only w i t h drugs.
g i a r d i a s i s brought
We
observed
s t a t u s (median:from that
of
61,0 those
T h i s suggests t h a t
about an
improvement i n ab
The r e s u l t s o f o b s e r v a t i o n s made over l o n g e r p e r i o d s are sum marized i n F i g . 4 and F i g . 5 The p a t i e n t s i n these cases were t r e a t e d by a t a b r i n e . The
serum
F i g .
4
throughout K.
vitamin A
(SVA)
increased
after
l e v e l s of
the
treatment
subjects
and
listed
remained
in
constant
the o b s e r v a t i o n . W i t h two p a t i e n t s Sz. L. (1955) and
J. (1957) r e i n f e s t a t i o n
l e v e l o f SVA reached
occurred,
and
depressed the
higher
earlier.
The SVA l e v e l s o f the c o n t r o l s d i d n o t change d u r i n g t h e p e r i o d of observation. The
SVA l e v e l s o f t h e p a t i e n t s shown i n
considerably The
F i g. 5
r e s u l t s o b t a i n e d w i t h two p a t i e n t s (K. B.
/1956/) are e s p e c i a l l y n o t e w o r t h y ; f e c t e d a t the b e g i n n i n g
b o l i s m was
observation.
/1957
arid
SVA
G.
J.
these s u b j e c t s were n o t i n
o f our i n v e s t i g a t i o n s , however,
r e a d i l y be seen t h a t t h e i r festation;
also a l t e r e d
d u r i n g the p e r i o d o f s e v e r a l y e a r s o f
l e v e l s decreased
a f t e r succesful treatment,
normal
i t can
following i n
vitamin A
meta
re-established.
Discussion The
a u t h o r s v e r i f i e d and a n a l y s e d the secondary v i t a m i n A d e f i
ciency
caused
of i t s special
by g i a r d i a s i s . symptomatology,
I t i s i m p o r t a n t n o t o n l y because but a l s o
t h e h o s t ' s T - e s i s t a n c e , thus r e n d e r i n g him
because
i t decreases
susceptible to
other
SVA IU/100ml
JPH m^ji
-
D
u «956)
n
n «953)
150]
P]
m «..n n 130] »I_JLJ3 1501
• n
D n
BL 0 (1969 B
F
m M-.^n 11 n n «957? m ml i . _ n l îoLa^J] 150] sLm^P « I n 50ÍJLJJ 150] n BJ I M J J T
1 5 ö
sol l ^ n
Ks n n U
30LD
50-LD 15 21 March
_ =^ I I û- q û
i
,
c:
n (1955) n M
8 : 1
LT
D
I
•
(4955) BM Q (1950 n Ll «957) SzL m (1955)
n
n
•
0
K
130] m 50LO 150] 150]
lî
a.
û ST
B
mm] SzL "
Q_Q imn SA
0
H (1957) BS OL
*
If
Fl «957) 5 19 3 Days-Napok April May Hónapok
Pig.
Treatment
•
- Kezelés
No c y s t s p r e s e n t i n stool Cysták a székletben n i n c s e n e k Cysts present i n stool Cysták a székletben
9
4 - 4. ábra
Changes Observed i n t h e SYA L e v e l Treatment D u r i n g 6 Weeks a f t e r with Atabrine. Control children r e c e i v e d no t r e a t m e n t . (The f i gures i n b r a c k e t s i n d i c a t e , t h e year o f b i r t h o f the c h i l d r e n . ) Az SYA változása gyógykezelés h a tására. A k u r a utáni változás 6 héten keresztül m e g f i g y e l v e . Kontrolnak választott egészséges gyermekek nem részesültek kezelésben. (Feltüntettük a születési évszámot.)
-^v Treatment - Kezelés ( Q SYA during i n f e s t a t i o n -
SYA a fertőzöttség a l a t t
UBS SYA without i n f e s t a t i o n -
Fig. 5 - 5 .
SYA a fertőzöttség után
ábra
Changes Observed between t h e Y e a r s 1964-66 i n the SYA L e v e l o f P a t i e n t s I n f e s t e d by G. l a m b l i a . The treatment w i t h the a n t i parasitic d"rug~~Tas"bed f o r 5 days. -
Az SVA változásának megfigyelése állami gyermekotthonban G. lamblia infestatioban, 1964-66 között. A kezelés esetenként 5" napos kúrát j e l e n t antiparazitás gyógyszerrel. -
diseases.
Since
i t occurs
causing
an inflammation
testine
that
may l a s t
mainly
i n the from
among p r e s c h o o l c h i l d r e n ,
upper r e g i o n
o f the
small i n
2 to 3 y e a r s , i t i s a s i g n i f i c a n t
c o n d i t i o n i n t h i s age group. With t h e s e f a c t s i n mind we attempted of v i t a m i n A metabolism caused elaborate
experiments
(probably
enzymic)
tabolism.
to remedy t h e impairment
by g i a r d i a s i s . More d e t a i l e d and
a r e needed
to e l u c i d a t e
the mechanism
by which i n f e s t a t i o n d i s t u r b s v i t a m i n A me
One r e a s o n why our work cannot be compared w i t h
n i c a l findings i s that
cli
the c h i l d r e n i n v o l v e d i n our study were
c o n s i d e r e d h e a l t h y by t h e i r p h y s i c i a n .
The change i n v i t a m i n A
s t a t u s cannot be a t t r i b u t e d to an adequate h o s p i t a l i s a t i o n
diet
a s h a s been claimed
by PALUMBO e t a l . ( 2 0 ) f o r we made no a l t e
rations
i n the u s u a l
whatsoever
everyday
diet
of t h e s t a t e
homes. F o r t u n a t e l y a number of well-known s c i e n t i s t s ( l , 28, 3 1 ) have
carried
out extremely
b o l i s m o f v i t a m i n A, and most o f the metabolic ROELS ( 2 2 ) e x p r e s s e s s u r p r i s e t h a t y e a r l y v i t a m i n A requirement
6, 7, 18, 21,
v a l u a b l e work on the-meta,although
s t e p s a r e known. an a d u l t
person's
c o s t s no more than 5 US c e n t s , the
f i g h t a g a i n s t v i t a m i n A d e f i c i e n c y p r e s e n t s such a g r e a t problem a l l over the w o r l d .
With people
s u f f e r i n g from
g i a r d i a s i s an
even g r e a t e r amount would n o t s u f f i c e to b r i n g the low v i t a m i n A s t a t u s back to normal, even w i t h l a r g e doses of v i t a m i n A supp lement. S i n c e MAKARA (12) e s t i m a t e s t h a t t h e r e a r e 300 m i l l i o n people diasis
this
should
i n the world be c o n s i d e r e d
approximately
who a r e s u f f e r i n g from g i a r a u n i v e r s a l problem. Of the
300 m i l l i o n i n f e c t e d persons 1 m i l l i o n l i v e i n Hungary. Most o f them a r e under 6 y e a r s o f age.As our i n v e s t i g a t i o n s have shown, in
o u r country
these
people
receive
vitamin A i n vain, f o r
whether i t i s i n i t s n a t u r a l form,or given t h e r a p e u t i c a l l y they cannot u t i l i z e i t .
According
to ROELS's c a l c u l a t i o n s ( 2 2 ) , to
supply 1 m i l l i o n person w i t h v i t a m i n A c o s t s 50.000 d o l l a r s p e r year.
Each y e a r t h i s sum would be spent to n o t e f f e c t a s f a r a s
the v i t a m i n supply o f the p o p u l a t i o n i s concerned.
V i t a m i n A d e f i c i e n c y , as we have l e a r n e d ( 2 , 10, 1 1 , 13, 23, 2 4 ) , i s a w o r l d problem. I n cases o f secondary v i t a m i n A d e f i c i e n c y , c o n s i d e r a b l e p r o g r e s s c o u l d be made by s c r e e n i n g and by removal o f i n f e c t e d i n d i v i d u a l s f r o m communities.Both p e d i a t r i c i a n s and n u t r i t i o n i s t s should be i n no doubt about t h e impor tance o f g i a r d i a s i s , w h i c h has an even g r e a t e r importance i n c h i l d r e n ' s homes. . • •
Acknowledgement The a u t h o r s thank Prof.O.WISS, o f Hoffman-La Roche and Company, Basle, f o r generous g i f t s o f v i t a m i n A p r e p a r a t i o n s and b e t a c a r o t e n e . We a r e g r a t e f u l t o Mrs. L i l i L. HUNYADY, Mrs. M e l i n d a H. PÁLMAI, Mrs. E d i t K. SZILÁGYI and Mr. G.PETHEŐ f o r t e c h n i c a l a s s i s t a n c e , t o Mr. L. BERÉNYI f o r p r e p a r i n g t h e f i g u r e s . We a r e e s p e c i a l l y i n d e b t e d t o Dr. G. MAKARA f o r h i s v a l u a b l e help, f r i e n d l y advice, c o n s t r u c t i v e c r i t i c i s m , and c o n t i n u o u s encouragement.
Summary I n two s t a t e homes f o r c h i l d r e n t h e v i t a m i n A l e v e l o f G. lambl l a - I n f e s t e d , s y m p t o m - l e s s c h i l d r e n was l o w e r t h a n t h a t o f those f r e e from i n f e s t a t i o n . Vitamin A supplementation given t o t e n c h i l d r e n r e c e i v i n g no c u r a t i v e t r e a t m e n t caused o n l y temporary improvement i n t h e i r v i t a m i n A s t a t u s ; b e t a - c a r o t e n e a d m i n i s t r a t i o n t o a n o t h e r group o f 10 c h i l d r e n , though i n c r e a s i n g t h e l e v e l o f serum c a r o t e n e ( f r o m 6 3 , 0 / g t o 152,0 /*g), d i d n o t a l t e r the v i t a m i n s t a t u s . Successful treatment w i t h a n t i p a r a s i t i c drugs r a i s e d t h e v i t a m i n A s t a t u s o f 25 c h i l d r e n f r o m a serum v a l u e o f 5 2 , 5 IU/100 ml t o 90,0 IU/100 ml expressed i n medians. The v i t a m i n A s t a t u s o f 10 cured c h i l d r e n who r e c e i v e d v i t a m i n s u p p l e m e n t a t i o n as w e l l d i d n o t reach a h i g h e r value t h a n t h a t o f p a t i e n t s who had r e c e i v e d drugs a i one.
O b s e r v a t i o n s made over
a longer p e r i o d suggest
t h a t there i s a
d i r e c t r e l a t i o n s h i p between the serum v i t a m i n A l e v e l and g i a r diasis . The r e s u l t s provide
evidence
f o r the p a t h o g e n i c i t y of G.lamblia
and g i v e an i n s i g h t i n t o the patho-mechanism of v i t a m i n A
mal
absorption.
E M B E R , M. — M I N D S Z E N T Y , L . : Giardiasis hatása az A vitamin anyagcserére
Két állami
nevelőotthonban
tünetmentes
serum A v i t a m i n értéke alacsonyabb egészséges gyerekeké. v i t a m i n t kapott követő napon. mutatott.
10 fertőzött gyerek n a p i
„A v i t a m i n k a p c s u l a "
cystahordozók élő
150.000 H.JL A
formájában,
két egymást
A-serum A v i t a m i n s z i n t csak átmeneti emelkedést
Nem okozott változást a serum A v i t a m i n értékben az a
napi 6 mg b e t a - k a r o t i n sem, kapott
Giardia
v o l t , m i n t a közösségben
amelyet
10
másik fertőzött gyerek
4 egymást követő napon keresztül. S i g n i f i c a n s emelkedést
mértünk
ezzel
szemben a
serum k a r o t i n
értékében (63,0 mikro-
gramról 152,0 mikrogramra, medianban k i f e j e z v e ) . l e n e s gyógykezelés hatására
25
A parazitael
gyermek serum A v i t a m i n
szintje
megemelkedett 52,5 N.E./lOO ml-ről 90, N.E./lOO ml értékre (mediánban k i f e j e z v e ) . meknek a
Nem emelkedett
serum A v i t a m i n s z i n t j e
magasabbra annak a 10 gyer sem,
akik a parasita
elleni
therapián kivül,A v i t a m i n t i s kaptak. Hosszú időn át tartó meg figyelésünk (6 hét,ill.3 év) i s a z t b i z o n y i t j a , h o g y a r e i n f e s t a t i o magával hozza a
serum A v i t a m i n
Vizsgálatainkkal a G. l a m b l i a
s z i n t újbóli csökkenését.
pathogenitását kivántuk bizonyí
t a n i , de betekintést nyertünk a z A v i t a m i n anyagcserébe i s .
R e f e r e n c e s 1./ AMES, S.R.:
F a t Soluble
371-402 ( 1 9 5 8 ) .
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Ann. Rev. Biochem. 2 7 :
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Amer.
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Buda
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